PROCEDURE TO LODGE A COMPLAINT WITH INSURANCE OMBUDSMAN

If you have an Insurance Policy on personal lines, group insurance policies, policies issued to sole proprietorship & micro enterprises and have a grievance against an insurer ( including its agents and intermediaries) or an insurance broker, complaint can be filed by Policyholder or claimant/legal heirs, nominee or assignee.

1. Please write to the Insurer/insurance broker.
2. The Insurer/insurance broker should deal with your complaint within 30 days.
3. If you are unhappy with the solution or if there is no response to your complaint from the insurer/insurance broker as the case may be, within for 30 days, then you can approach the Office of Insurance Ombudsman as per jurisdiction for value of the claim including expenses not exceeding 50 lakhs, within 1 year from date of rejection/repudiation/partial settlement of claim by the Insurer/Insurance Broker. For jurisdiction please Click here.
4. You should not have approached any other forum/court/arbitrator on the same subject matter of your claim.
5. The forum of Insurance Ombudsman does not charge any fees for filing the complaint

The Ombudsman shall receive and consider complaints alleging deficiency in performance required of an insurer (including its agents and intermediaries) or an insurance broker on any of the following:

1. delay in settlement of claims, beyond the time specified in the regulations, framed under the Insurance Regulatory and Development Authority of India Act, 1999;
2. any partial or total repudiation of claims by the life insurer, General insurer or the health insurer;
3. disputes over premium paid or payable in terms of insurance policy;
4. misrepresentation of policy terms and conditions at any time in the policy document or policy contract;
5. legal construction of insurance policies in so far as the dispute relates to claim;
6. policy servicing related grievances against insurers and their agents and intermediaries;
7. issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer;
8. non-issuance of insurance policy after receipt of premium in life insurance and general insurance including health insurance; and
9. any other matter arising from non-observance of or non-adherence to the provisions of any regulations made by the Authority with regard to protection of policyholders’ interests orotherwise, or of any circular, guideline or instruction issued by the Authority, or of the terms and conditions of the policy contract, insofar as such matter relates to issues referred to in clauses (a)to (h).

The complaint shall be in writing duly signed by the policyholder or claimant/ legal heirs/ assignee/ or through electronic mail or online through the online platform developed by the Council of Insurance Ombudsmen through their website www.cioins.co.in. Click here to download Complaint form.

The complainant can send his complaint letter alongwith photocopies of the supporting documents as given hereunder to the Office of Insurance Ombudsman either through post or through email.

1. Policy copy ( all pages of policy under which complaint is lodged)
2. Copies of all old policies for covering of Insurance since last 48 months prior to this policy if claim is rejected on grounds of pre-existing diseases/waiting period.
3. Repudiation/Denial letter/Partial settlement letter issued by the Insurer.
4. Representation letter sent to the Insurer/Insurance Broker.
5. Any other correspondence exchanged with Insurer/Insurance Broker & TPA.

The complainant can also register his complaint online on our website www.cioins.co.in under heading “Register” - Lodge/Track Complaint Online. He can upload the above documents as also proof of identification, photograph on the online registration platform. Please refer FAQ under the heading Lodge/Track Complaint Online for more details.